This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Sunday, 13 December 2009

Nurse Anne Gets Owned by a Consultant PART 1: The Intro

Argghhh. I hate it when we get moved off of our ward in order to staff one we are unfamiliar with.

Yeah yeah I am fine. It's been a long time since I got verbally murdered by a doc. I have been a nurse a long time, I know how to treat a doctor with the respect she deserves (at work anyway) and I know how to get things done and done well in less than ideal conditions. I never have any run ins with the physicians. Of course all that applies to the specialty I work in currently and most of my career. I am a general medical ward nurse. I can handle general surgery basics as I spent a few years doing that. But anything else and I am out of my scope of practice.

Nurses do not graduate from nursing school knowing how to work alone in every speciality. That is impossible these days. Impossible. If they wanted to graduate nurses with that kind of knowledge they would have to keep them in nursing school for ten years.

Definiting of Floating: Floating is when a site manager has 3 nurses on one ward and 1 nurse on another equally large floor. They will send one of the three nurses from the first ward to cover the second. This is the case even if it is an area that she has no experience in. They are covering their asses and putting the patients at risk and the nurse's license at risk when they do this. The NMC tells us that if we are asked to do this and feel that it is unsafe we should refuse. The hospital bosses tell us to float or else. They will not accept our explanations as to why it is unsafe. They think nurses merely make beds and bedbath and feel that we should be able to do that anywhere. Refuse to float and your job is on the line. Float and your license and your patients lives are on the line.

A medical nurse who has only every worked medicine would be like a fish out of water on a surgical ward. A surgical nurse who gets sent to medicine for the day would be out of her depth. Sending me to ITU would be like signing death warrants for those patients. And when they send ITU nurses to general medicine they are in tears over trying to do a drug round for 20 people. In tears. They cannot handle not be able to assess patients properly and dividing their attention between more than 2 patients. An RMN cannot function on a general medical floor. The powers that be tried to use an agency RMN to take a side alone on my floor once. I would not know where to even begin on a psychiatric floor nor am I at all familiar with the drugs they use etc.

In the USA they staff their maternity floors and psyche floors with registered nurses rather than midwives or RMN's and have been known to float those people to work in charge on medical floors. Not safe. Those nurses may be registered nurses but if they are working in maternity and psyche they don't know dick about working on a medical floor and vice versa. They are no longer familiar with those drugs, the diagnosis, the interventions that those patients need etc. It's a mess. But floating is what hospitals do to try and cover up the fact that the staffing ratio matrix that they use is a joke and it is what they do to cover up the fact that their lack of investiment in hiring and retaining people on the frontlines is a total fail and it is murder.

I arrived to work one tuesday morning to find that there were three of us-registered nurses- to staff my large medical floor along with 3 care assistants. Not enough but better than the usual.

Then the phone rang. It was the site manager. "One of the trained nurses has to staff a surgery suite for short stay and day surgery. There are just not enough beds and many elderly medical patients who came in overnight ended up in beds on surgical wards. Those beds were earmarked for incoming surgery patients. We are putting the incoming surgical patients into this thing we opened up on the third floor and praying that some of the beds on wards are vacated by the time they come out of theatre."

Oh shit. This sounds like a clusterfuck in the making. The other two Registered nurses I was on with (Julia and Kate)had both floated recently and it was my turn to go. Yesterday Julia was sent to staff a bay for overflow a&e patients. She started work at 0700. She was due to finish at 3PM. No relief showed up for her as the site manager had no one to send at 4PM..

It is illegal for Julie or any registered nurse to leave until she could hand over to an incoming RN. If there is no incoming RN you are legally mandated to stay even if your pissed off babysitter is about to walk out on your 2 year old because you are late. If you don't stay it is patient abandonment and you will be struck off. She was there until past 7PM. That is when they finally send her some relief. She will remain unpaid completely for those extra hours. She was not keen to have another go at floating now that her childminder walked out on her for picking up her kids 4 hours late. Julia may not have received payment for those hours she was legally mandated to cover unpaid. But she still had to pay the childminder.

Kate had also recently floated. She had been sent to colo-rectal surgery. She had 12 patients there and failed them all because she didn't know that area of nursing nor did she know the floor. She was just dumped down there with no support. This is what happens to us when my ward sister staffs my ward with 3 registered nurses. One usually gets sent away.

Nurse Anne on the other hand, hadn't floated in months. So it was my turn to run up to and staff the clusterfuck hastily put together "surgical suite".

Oh shit.

Let's set the scene even more. They hastily opened this place to take overflow surgery patients who were all scheduled to have their ops today. The place wasn't prepared, there was no notes, I don't really know the routine with surgery any more or how to prep the patients excactly. I didn't know where anything was. And I was alone up there with an agency HCA who never worked in a hospital before.

And I don't know a goddamn thing about gynaecology anything. Not a goddamn thing. Not at all. I don't even think we ever really covered that in depth in nursing school. I never worked in gynae in my life. I have female bits and I know where they are. That is the extant of my knowledge about gynae. Just to reinterate, I do not know the first thing about gynae.

And this is where it all went to hell.

But how badly can you screw up with a short stay gynae patient? It's not like it's coronary care right?

20 comments:

It cannot be legal to force someone to work for 4 hours without pay. If it is legal, it can then be used as a means to staff the hospital for free. Is there no authority in England to enforce labor rights? I cannot understand why anyone would endure this treatment.

Sometimes they pay us and sometimes they tell us to take it back later as comp time. But you rarely can take comp time because of short staffing. Over the summer they were paying overtime for these kinds of situations after a long period of refusing to do so. But now they are back to refusing to do so.

Sometimes they pay us and sometimes they tell us to take it back later as comp time. But you rarely can take comp time because of short staffing. Over the summer they were paying overtime for these kinds of situations after a long period of refusing to do so. But now they are back to refusing to do so.

I think you all need to get the union involved at this point. It should be ILLEGAL to withhold pay to someone. Comp time would fly in a 9 to 5 Monday through Friday type of environment, but DEFINITELY not in the environment you are trying to work in. They are cheating you out of money. What they are doing is called slavery in a civilized world. Do you have a union? You don't have to strike, but you definitely need to file a grievance en mass. And while you're at it, you need to contact some serious media and go public. Yes, I think it has come to that. Do you have representatives in the government? Get on the phone with them! Write letters! Demand that the pay laws be changed. AND start documenting every time they force you to work without pay. Dates, times, everything, who you talked to, who denied you pay. Get your co-workers to do it, too. There is strength in numbers. You and other staff members will have to stand in solidarity on this. The blog is not enough. Educating the public will not make your situation better, Anne. You and your colleagues must stand together and fight! And to hell with public opinion! The public will not deal justly with you just because they may like you better.

"They are covering their asses and putting the patients at risk and the nurse's license at risk when they do this." - oh you so know I am going to argue with that - bollocks Anne. They are trying to get anyone - ANYONE to take care of the patients. We are all trained nurses - surely it is better that SOMEONE (trained)is there trying to get them their drugs, the toilet...to Theatre. I'm not covering my own arse when I move staff - I'm trying to stop a ward full of patients not being looked after.AT ALL. Not being paid is a different matter, that's rubbish and you should be, but please don't give me the crap about puting your license at risk by manning an area that has no staff. It has to be better than no-one there at all.

But there are better ways for them to cover sickness and sort wards with no staff than floating nurses.

Floating nurses to unfamiliar areas is not the way for them to do things. It is a pity that they leave you with no choice but to cover wards this way.

Every hospital should invest in a large well trained pool. I have worked in hospitals that have hundreds of people showing up each day and each shift for the "pool".

When they arrive at work they are told where to go i.e "ward 4 is down two staff nurses and you have been orientated to their environment-off you go".

Once they cover all the sickness they use all remaining poool staff to cover things like breaks. Or go to wards where each nurse already has 6 patients but the ward is expecting admissions. The pool RN will take the admissions. They also use pool staff as a one to one i.e sitting with a demented patient on a ward who is wandering.

Once when I worked as a pool nurse they already had every ward covered but I just took over for lunch. The RN would hand over her 5 patients to me and go to lunch. When she came back I would relieve someone else's break and that was my day.

They invested a lot in the pool. And the pool staff were constantly cross trained in all sorts and updated. They are a good investment for hospitals to make and they made what regular staff do. They were not agency. They were all in house staff. They covered maternity leave...all sorts.

Young mothers loved working on the pool because you could pick you shifts. I enjoyed it as well. There was an RN pool and a Care assistant pool. It is a hell of a good investment.

Taking staff off of one short staffed ward to cover a no staffed ward is fucking gay and you guys should not be forced to do it.

Nurses should not be coming into work sick. They need to concentrate etc. When I worked in a department store I would probably show up for work with tonsillitis. It's not like I would be dealing with neutropenic people or working for 12 hours without a drink. But as a nurse? No way.

I do think they should stop paying people for short term sick leave -the odd day off and only pay for long term sick. That would put a stop to the few that take the piss.

And the boards of nursing will pull a nurses license if she agrees to float to an unfamiliar area and SOMETHING HAPPENS TO A PATIENT AS A RESULT.

They will. They are upfront about the fact that they will do this.

They don't care if emergency staffing/bed issues at the hospital forced the bed manager to force the nurse to float. That is beside the point to them.They will strike her off.

Accepting an unsafe assignment is considered a reason for the NMC to take action against an individual nurse. They do not care what the conditions were like at the hospital. That side of things is not their problem

I agree - Pool nurses are the way to go, but round my way we've just introduced them (AGAIN) and the problem is that if, for some miracle, all the wards are fully staffed, and we place them somewhere that is just busy, but not short, the wards are so uptight about their budgets that they are refusing to pay for them, and so, nurses are refusing, quite rightly, to work on the Pool. We have tried explaining the cost savings when they get a pool nurse vs an agency nurse, and that it will probably still work out cheaper, let alone better for the patient, ...but so much pressure is put on the ward managers about their bloody budgets that the message just does not seem to be getting through. And I know that you are entitled to refuse to do anything that is outside your sphere of competence, but I still have to argue with nurses who think it is OK to threaten to leave a ward and go home, as they are "putting their registration at risk" by staying on a badly staffed ward. I tink the NMC would have a hard time not striking off a nurse who did that, leaving the ward even more dangerous than when they were there.

I used to work in an area that was very unsafe if there was a call-in. We had no floats, and it was critical care along with very confused and combative dementia patients (they were very ill as well). After a few very scary shifts and leaving work in tears, I wised up. I stopped clocking in and would not take report before I assessed the situation and determined that there were enough staff to safely care for the patients. I think my NM got wind of this and soon after I started this practice, Voila! We had coverage. I informed my co-workers I would rather lose my job than my license. But I was a good nurse who worked hard and took good care of my patients. I think that's what saved my butt. Bless your heart, Anne. I don't know if your management is smart enough to try to retain a good nurse if she stood up to them against unsafe conditions. Nurse Ratchet, I'm sure you're a good soul, but my loyalty is with MMN on this issue. Enlightened members of management (including yourself) should be standing up for your staff and speaking out on their behalf to the people who could change things for the better - not hanging them out to dry with that tired old "Not enough staff is better than no staff" rationalization. After all, the staff nurse IS the one who will have the bull's eye painted on her forehead if a sentinel event occurs and harm gets done. So your argument does not hold water. Sorry.

Oh Anon, believe me I do stand up for my staff, untill I am blue in the face, again and again we tell "management" that just because a patient has not had a laparotomy does not mean that they need less care... Medicine gets the least staff, the least resources, and the most challenging of patients.As Anne knows, my hat is firmly off to her and others like her who continue to give a shit in very difficult circumstances. Mine is not an "argument" - it is my daily challenge - to keep the patients as safe as possible....if the staffing templates were half as good in medicine as they are in surgery I wouldn't have to stretch my already overworked nurses and further, but, until the staff/patient ratios increase, that is what I have to do.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.